12-103519 ECEIVE - I b 3 S1
Feder W R PERMIT SF MF CO ME PL DE EN m
COMMUNITY DEVELOPMENTSERV4 p 31201APPLICATION
253-835-2607•FAX 253-835-2 9`'
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CITY OF FEDERAL WAY
CDS
SITE ADDRESS SUITE/UNIT#
35025 Enchanted Pkwy.S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 1,100.00 1 8 5 2 9 5 _ 0 0 3 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Trampoline Nation
Add new fire alarm devices to existing system to accomodate new tenant.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER FANA Federal Way Crossings
MAILING ADDRESS E-MAIL
1621 114th Ave SE Suite 132
CITY STATE ZIP
Bellevue WA 98004
NAME PHONE
Kirby Electric Inc.-Paul Hoskins 253-859-2000
MAILING ADDRESS E-MAIL
CONTRACTOR 4826 B St.NW Suite 101 paulh @kirbyelectric.com
CITY STATE ZIP FAX
Auburn WA 98001 253-859-2363
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
KIRBYE1077BN 01 13 / 13 19-90-101897-00-EL
NAME PHONE
Same as contractor
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and Same as contractor
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted In support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit.I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: DATE
PRINT NAME: 7 G
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Petntit Application